Home Forums Use of Updox patient portal

I'm sure this must have a thread somewhere, but I'm not finding it-- apologize for being stupid.

I'm having difficulty figuring out the best way to use Updox portal.
Should I print what I want to send to the patient to the Updox main screen, then send that to the portal?

What exactly is the interface between AC and Updox?

I'm going to have to figure this out if I am to certify for MU2 -- but all I can see is incredible hassle for me, and especially for my staff; holding hands for the little old ladies and men who constitute much of my practice, and who really can't find their way around G-mail.

Thanks for any assistance.

From what I understand the basic functionality of updox will be built into the version of AC that will be released for MU2. The MU wizard within AC will walk you through what will need to be done to meet that core requirement. It will only need to be done for the 90 day period the first year of MU2. That's what I heard at the ACUG Boston.

It was recommended that we begin to collect email info from our patients. Just like with MU1, these measures will need to be done for only a percentage of patients.

Tom,

My perspective may be viewed as "stupid", at least several of my partners probably think I am, but have not told me to my face, and I would not blame them if they did.

However, I am of the opinion trying to capture any of the meaningful use dollars is extremely inefficient for me. So I do not care about capturing any of the meaningful use money. I have already made more than enough to pay for my investment in transitioning to an EHR, by my improved efficiencies.

So with that being said, I saw over a year ago how critically important a patient portal would be to enhance efficiency. I will list several lessons learned along the way, and by no means do I have all the answers, but the portal has been single handily the best change I have made in 20 years of practice.

#1. Your nurse will be your best advocate to get it going.
#2. If your patient does not have the skill or interest in setting up a portal, do not waste your time.
#3. At the time of the patient visit, you need to sell it, your nurse needs to not only sell the idea, but get the email address, create a portal account, print up the information, and hand them a typed up set of directions on how to access and utilize the portal.
#4. I tell my patient there will be a summary of the visit viewable within minutes of leaving the office visit, instruct them how to access the summary and message back so they get comfortable with conversing in this fashion.
#5 Initially the set up is labor intensive, but the savings in reduced postage, phone tag, voice mail and improved communication has been nothing short of mind boggling.

If you want any assistance or ideas just let me know.

I hope this helps.

Tom,

I just realized I did not answer your question.

What I do is print my summary of visit to the Updox workspace by clicking on the Updox printer.
This summary then arrives in the Updox work space.
My nurse will then run her cursor over the summary in the Updox workspace and check the box at the bottom, and then hit send this one page tab. Another screen pops up and she starts typing in the patients last name and it pops up and clicks on name. Then she hits send to portal tab. Up pops another screen and she can add a subject and short message. Also there is a box available to choose a template. If you have any templates you want to design such as diet or exercise etc, these can be attached to your summary by choosing the template, and then she hits the send button.

Once the patient reads the summary +/- template, you will be notified in the Updox workspace.

I can do this as well but find it works best if my nurse does this busy work.

Sounds complex but really takes seconds to do once your nurse gets the routine down.

Here's how we are using the patient portal.

1. On our registration form we ask patients if they want electronic access to their records. If so, they give us an e-mail address, and we enter it in the demographics area of AC.

2. Since the Patient Portal in Updox is enabled, an account is automatically created for the patient when an e-mail is added in step 1, and the welcome e-mail message is sent to them to authenticate their account and log-in.

3. At the same time our staff enters the e-mail address, they also set a flag in AC that the patient has electronic access.

4. At the end of every encounter (or end of day) we print summaries for all patients, to meet core 13 requirement. When we do this, if the patient is flagged as having electronic access, instead of printing the summary, we export it to Updox.

5. Once the CCD is exported to Updox, it appears in the general practice items inbox, we simply hit "send to portal."

I thought emailing information to patients, etc was against HIPAA? How do you get around that? This office does like to obtain patient's email addresses but I dislike the use of them because of HIPAA. Does this mean that anytime I key in an email address in the AC system that it automatically sets patient to get access and emails from the chart? I wouldn't want that.

Updox isn't regular email. It is a secure messaging system and is HIPAA compliant. Basically, the patient only gets an email that says "You have a message from Dr. X." Then they go and log onto Updox to view the message. It only resides on Updox's server.

HIPAA requires an secure email, which my understanding is what Updox has.

That said, I do not know whether AC automatically will set up an account through Updox (I do not currently use it.)

Updox has a free secure messaging system(https://www.myupdox.com/get/).

My guess is since this is a MU2 requirement, AC got them to allow automatic inclusion in the new version. Probably a good recruitment tool: "See how good we do this, for only $x.xx you can have all that!"

After reviewing the information, I actually signed up for the free portal (I had been intending to do that but never did...) This went smoothly. Now as to using it.....

If you've enabled the Updox Patient Portal, then every patient with an e-mail address entered in AC will have an account in the Patient Portal. When the account is created (either when Patient Portal is made active, or an e-mail is entered in AC, whichever occurs later), the patient will get an e-mail saying an account has been created, and giving them their username and password to access the sight. They then will be able to see anything you transfer to the Patient Portal.

This free system is only for "doctor-to-doctor" communication. Your patients cannot sign up for it, but say if you are PCP then your specialist partners can sign up for it.

NeuroDawg,

When utilizing this method have you had any patients more confused trying to sort through and/or make sense of the CCD. Or have any instances of medications in the CCD not match your recommended list.

I am only mentioning this, not to berate your method, but find the information contained in the CCD extremely confusing and med list not always accurate. For these reasons I have stopped sending out the CCDs.

I am curious if you have encountered any issues with patient confusion associated with information contained in the CCD, and if so how do you handle this?

jimmie,

Damn you! You got me looking closely at the CCD. While I don't see discrepancies in medication lists, I have just discovered that the CCD doesn't include any of the "Plan" in the encounter. Only data put in the assessment box is included in the encounter. Anything in the Plan box is excluded. That's a huge problem.

NeuroDawg,

Damn you! I was hoping you had a slick fix I was unaware of. The medication list discrepancy would only intermittently occur, and I could never quite figure out any rhyme or reason.

However, since I could not figure that out, and what you mentioned, I just started sending the summaries out only to avoid confusion.

NeuroDawg,

When you set the flag to indicate a patient has a portal account, do you find that helpful. I have not tried that method.

What I have done is click on address book in the Updox workspace and type in patient name, which will indicate an active portal or not.

Would you mind commenting on how those two processes differ, and if you think one is better than the next.

When I am typing patient lab letters in AM, I will need to know if they have a portal or not so I can type to paper or print to Updox.

So a quick way to reference to find if a patient has a portal or not, is quite helpful.

I find the flag extremely useful, since this is the only flag we use. So as I am completing an encounter, I see the flag there, and know that when I am done I need to export the CCD to the Patient Portal.

It wouldn't be as efficient if we used mulitple flags, because then I would have to click open the flag to see if the patient has electronic access. Although I think that this would be faster than moving to Updox and checking in the Updox address book.

I don't type lab letters (or any letters, actually) so I don't know if you see the flag when doing so. If not, then you would have to type the patient's name in the patient list and see if a flag pops up.

Hope that helps.

That is extremely helpful, I may give your method a try.

I do use flags for other reasons, so this method would not work for me. However, I can just click on demographics and if they have an email address there, then they have a portal account as it is set to automatically create a portal account for every email address.

That works too.

Thank you all.

We are working on ways to use the system in our office.
As usual, it is work-flow issues.
Jimmi -- I don't think I can drop one more "computer" task on my nurse without having open rebellion!
But I see some hope, and a few of my elderly patients are really quite tech-savvy and are interested in this.

Tom,

If you want a full blown mutiny, I will have your nurse talk to my nurse. Seriously, as you start to integrate do not hesitate to contact me and send me a PM antyime. At some point if you are interested, it might not hurt to have your nurse talk to mine--she loves it now that most of the kinks have been worked out.

The trick is to show her how the computer tasks will actually make things easier and save time for her and everyone else in the long run. Once she realizes that she is not doing more, but actually doing less it gets real easy.

Thanks, Jimmi --
I'll run it by her.
You may get a call from me.

I am not involved in MU stuff, so I only use the system where it does good things for me or my patients. Over 95% of our patients use e-mail, and we explain that they will need to come in to discuss results if they cannot access them electronically. I cannot efficiently do telephone tag any longer. Here is my flow:

If a lab comes in from Quest, I print it to the UpDox printer, send it to the patient portal. I then send the result to the patient with comments which may or may not be templates. I do this myself; my nurse would not know what comments I wanted to make. I copy the comments (Cntrl-A, Cntrl-C) before I hit "Send". Then I return to the lab signoff screen, paste the comments into the sign-off window, and sign it off.

Things coming in as Faxes are already in UpDox. My staff assigns incoming documents to the correct provider by setting a colored flag in UpDox, and the provider filters for his/her tag. I will import to the chart, and if appropriate (say, an x-ray result) will send it to the patient via the portal, again with comments.

If I want to just send a message to a patient, I will hit "Create" in UpDox, and send a message to the portal. That remains secure and compliant. Patients can initiate secure messages to me via the portal as well.

Because of the need for make medical decisions based on whatever I send, I do not involve staff in any of this beyond the initial filtering of incoming faxes. It takes me about 15 minutes in the morning to do everything. I do it when I first get to work and am drinking a cup of coffee. I do not consider it odious.

David: I respect your efforts to speak with the patients personally and appreciate you posting this workflow. I am always interested in hearing other workflow patters to help improve my own efficiency. I have one major concern about the portal. Normal labs are no big deal. However, for an abnormal lab, or abnormal imaging, I wonder about the medicolegal ramifications. If I send an abnormal lab to the portal, they can say they never got the email. If I have my nurse call them, or call them myself, I can chart that the patient was informed of labs, imaging, etc and the plan discussed. I don't know if the portal shifts the responsibility for follow up back to them as well as a phone call does. However, I do trust my RN to tell a patient her mammogram was abnormal and needs a repeat in 6 mo.

Chris,

When sending a result to the portal, just make sure you set that you will be notified if the item is not viewed. The time frame to be notified can be anywhere from one hour to one week. We set ours to one week, and if not read then my nurse will call.

You find this setting when sending an item to a patient. It is directly below the message box, and there is a sentence that says "If this item is not viewed in the portal, alert me in...." Click on arrow to set your time frame desired.

Also I have the "Enable message read notifications", a confirmation will be sent to your practice workspace when a patient views a message you have sent to their portal account.
This is found by clicking on portal, then portal profile, then click on "Enable message read notifications halfway down the page.

This is extremely helpful to do both to take care of your problem, I think.

That is a good option. We use the "notify if not read" option in cases of abnormal lab results. For seriously abnormal results, Alice both sends the message and calls them.

What about later, if there is a problem from an abnormal result, the patient is angry, and falsely says it was never sent? Can you prove that you never got a message saying it was unread? Can you prove they read it? With a nurse calling I have documented it was discussed and by whom, and the nurse is a witness.

If they open the message, it will show up on the portal as read, and then if you archive that it will be in the archive section for 6 months for review on the server at Updox as I understand it. Who really reads it? It would have to be someone who knows the password and have access to the patient's email account, probably more targeted than regular mail.

I think all you can prove is if the message is sent and if it is opened up or not by the patient. We set the interval at one week if the message is not opened by the patient, then we are notified in the Updox portal.

Usually, I send results electronically that are normal or stable or easily understandable. Anything that is abnormal, will usually need a phone call and usually an appointment for face to face.

The portal is great for lab results printed from Quest, with a letter generated in AC attached, a few days before visit, even if abnormals are present.

Also great for attaching the templated letter for normal pap or mammogram results attached to the actual report.

The letter to recommend a 6 month f/u mammo could be attached with the actual abnormal mammogram report, and a reminder in AC to have your nurse order a 6 month f/u mammo as a backup. However, I usually call or have my nurse call in addition to doing this to avoid any mess up. This is better than just a phone call because patients can read it in black and white as well as a friendly voice over the phone, and takes very little time to do this extra step electronically.

Also, after an office visit, anything ordered as discussed such as xray, HIDA, MRI etc. will be sent (with short letter) as soon as I get results, and if abnormal, usually a visit afterwards, but patient can read results on portal before f/u visit to think about and discuss at visit. If results normal, the f/u is not necessary.

I think the portal has served a nice niche for getting out results lightning speed and very much appreciated by patients. I would argue if used properly, much better than the old snail mail or phone by itself, in some instances.

I have a husband and wife both blind and the portal has been quite helpful for them since their sighted relative moved away. Also, a deaf patient has found it extremely helpful to communicate in this fashion.

Like any mode of transmitting patient information, it has its positives and negatives, so am still trying to learn along the way.

However, all of these electronic transmittals are documented and kept in AC as part of the permanent record.

However, all of these electronic transmittals are documented and kept in AC as part of the permanent record.

_________________________

So it sounds like you are saving both the read receipt and the not-read notification? Certainly if you attached a letter form AC that would document your discussion as saved on the chart.

Chris,

I always save the letter and report/result in AC.

The "READ: Results" golden bar appears right away in the Updox work site, as patients look at the letter attached to report, and once my nurse archives this, is saved for 6 months by Updox.

One nice additional feature I use quite a bit, is click on Address Book tab on the main Updox page, and type in patient name, click search, and then click on the patient name. Once you do that click on messages tab. You will have a nice summary of the following:

1. Portal inbox messages- unbolded read messages and bolded unread messages.
2. Workspace Inbox, Sent, and Archived messages all timed and dated.

This is a nice record of all the electronic transmittal of information for this individual patient with a portal.

You can change your settings in Updox so that archived and saved items remain in the system for 6 YEARS.

Thanks Carla_FNP!!!

I just changed sent and archived from 6 months to 6 years, I did not know you could do that.

Click on Admin tab on Updox main page, then click practice profile tab, then click on settings tab, then you can set your sent, archive, and trash settings.

Trash is a maximum of 30 days.

One other facet to the Updox portal that is taking hold for my practice is for those elderly patients who are comfortable with communicating in the traditional manner but have an adult son or daughter, usually the POA, who want to be included in the communication pathway electronically.

I sit down with my patient and their relative and explain what will occur, have them think about it, and once I get a signed consent from the patient to share the information, will create a portal account on behalf of the patient to the designated family member.

My patient will receive everything I send the designated family member, just 2-3 days later by paper.

This has been extra work, and not for everyone, but has been much appreciated especially the marginal patients wavering on or already at assisted living, and family members out of area.

However, if you select and screen the appropriate family member/patient this approach can be an asset to one's practice, and be very reassuring to families.